Over the past decade, there has been an explosive increase in obesity among all age groups within the US population. This epidemic is particularly problematic among African-Americans in the Southeast. Although genetic factors play a contributory role, it is postulated that ethnic disparities in obesity and obesity-related cardiovascular disease (CVD) is related to a dynamic interplay between biological factors and the behavioral response to the unique environmental context within ethnic communities. Obesity is often associated with perturbations in the metabolic and physiologic milieu. A cluster of obesity-related abnormalities has been defined as the "Metabolic Syndrome". The CVD complications of obesity appears to be related to the capacity for adipose tissue itself to generate "adipokines" that directly predispose to insulin-resistance, endothelial dysfunction, inflammation and vascular disease. The proposed program will use state-of-the-art approaches to define potential ethnic differences in the profile of metabolic, physiologic and biochemical features associated with obesity as well as the salutary responses to lifestyle modification. The proposed program uses a multi-disciplinary strategy to systematically characterize potential ethnic differences in obesity-related CVD by drawing upon the fields of psychology, physiology, biochemistry, nursing and clinical medicine. In a thematic series of inter-related studies, our Program's research plan ranges from: epidemiology studies within the ethnic communities, to patient-centered clinical trial interventions within ethnic community practices, tothe analysis of novel biomarkers of human pathobiology. This collaborative multi-investigator team is built upon a complementary partnership between the Morehouse School of Medicine and Emory University. This partnership shares a joint commitment to address the striking ethnic disparities in the high-risk CVD population that we serve. The specific aims are: Aim 1: Define the relative influence of psychosocial/cultural factors and biological mediators as determinants of ethnic disparities in obesity and the metabolic syndrome in a population-based bi-racial cohort. Aim 2: Define the effectiveness of patient-targeted behavioral interventions to enhance the health of African-American patients with the Metabolic Syndrome in the context of community-based clinical practices. Aim 3: To assess the impact of innovative lifestyle intervention strategies on conventional and novel biomarkers of vascular disease risk in African-Americans. Aim 4: To enhance the education/training of fellows/practitioners engaged in CVD disparities research/practice and promote partnerships that enhance cardiovascular health within ethnic communities.